Birmingham area hospitals past peak of COVID-19 cases, CEOs say

Shelby Baptist Medical Center 3-31-20

Shelby Baptist Medical Center in Alabaster, Alabama

While the Birmingham-Hoover area has been one of the hot spots for COVID-19 in Alabama, it appears the area has passed the absolute peak of cases, the head of the Brookwood Baptist Health System said in a town hall videoconference organized in Hoover today.

However, there are still concerns about the potential for a second surge of cases now that the state’s stay-at-home order has been modified and people begin circulating more, Brookwood Baptist CEO Tim Puthoff and UAB Medical West CEO Keith Pennington said.

The two hospital chiefs answered questions posed by Hoover Mayor Frank Brocato and about 40 others who attended a videoconference organized by the Hoover Area Chamber of Commerce.

Puthoff said Brookwood Baptist Medical Center reached its peak of 11 COVID-19 patients at one time last week and currently has 10 such patients in the hospital. Pennington said the most UAB Medical West had at one time was 10 COVID-19 patients. UAB Hospital had many more cases and handled the volume well, Puthoff said.

Both men said their hospitals thankfully were never overwhelmed and had enough intensive care beds, ventilators and personal protective equipment to handle the task.

However, there still have not been 14 days of a downward trajectory of cases, which is one of the three criteria the White House recommends be considered for phasing out restrictions on mobility and business operations, Puthoff said.

NURSING HOME CONCERN

Their biggest concern right now is nursing home patients, the CEOs said. There have been outbreaks in some facilities, and that is where the majority of current in-patient COVID-19 cases have originated, Pennington said.

“They’re the most vulnerable people in terms of an outbreak,” Puthoff added.

Photo courtesy of Brookwood Baptist Health System

Tim Puthoff

Tif Puthoff, CEO of Brookwood Baptist Health System

He noted the first big outbreak in the United States came from a Seattle nursing home. “It really went through that place like a knife through hot butter,” Puthoff said.

Shelby Baptist Medical Center, a part of the Brookwood Baptist Health System, created its own makeshift nursing home within the hospital to treat nursing home patients with COVID-19 there instead of sending them back to the nursing home as quickly as usual, Puthoff said.

Pennington said UAB Medical West is testing all its patients from nursing homes for COVID-19 even if they are not showing symptoms, just because nursing home residents tend to be at risk of more severe complications from the disease. Some nursing homes are even requiring that patients get two negative results before the patients are allowed to come to the nursing home, he said.

That has resulted in longer hospitals stays than normal, Pennington said. Puthoff said the average length of hospital stays has increased 15 to 20%.

EMERGENCY ROOM VOLUME DOWN

The number of people coming to their hospital emergency rooms for any kind of treatment is down about 50%, the two CEOs said.

A lot of people are less reluctant to come to the hospital because they’re afraid of getting COVID-19 there, Puthoff said. He believes that fear is unwarranted because of the isolation measures that are in place for COVID-19 patients, but it’s understandable and something that is taking place across the country, he said.

Puthoff said he is concerned that some people may not be seeking needed treatment that the hospitals could easily give if the patients came.

Also, he and Pennington both said they’re glad to be able to resume elective medical procedures. Puthoff said some people’s medical treatment that may not have been as urgent six to eight weeks ago now may be more urgent in order to ensure appropriate outcomes for those patients, whether they are dealing with cancer, cardiac issues, pain management or orthopedic issues.

Hospitals in the Birmingham-Hoover area now believe they have the ability to care for both COVID-19 patients and those other patients as well, Puthoff said.

FINANCIAL BURDEN

Regarding financial concerns, both Pennington and Puthoff said they can’t speak for other hospitals, but they believe Birmingham area hospitals should be able to weather this storm.

Puthoff said it has been incredibly challenging financially, but the impact has been lessened somewhat by the availability of federal grant money. Also, Medicare has advanced payments the hospitals would have received in the second quarter. That money will have to be paid back, but it helped, he said.

The long-term impact remains to be seen, but health care is somewhat recession proof, Puthoff said. “People are always going to need it.”

While urban hospitals are more financially secure, some rural hospitals in Alabama were struggling before this happened, Puthoff said.

“They’re in a much more tenuous position than a lot of the larger hospitals that do more procedures and have higher-revenue type patients and, in many cases, a little better payer mix,” he said. “It remains to be seen. I’m sure that this will have a long-term impact around the country. I wouldn’t be shocked if there weren’t at least some acceleration of hospital closures around the country.”

Rural hospitals operate on a much thinner margin than urban hospitals, he said.

LASTING IMPACT

Brocato asked the hospital CEOs whether they see people doing things differently as a result of this pandemic.

Puthoff said this crisis likely will spur the production of more critical personal protection equipment in the United States, versus relying on foreign trade partners to provide it.

Health care providers have realized they need better assurance of continual access to those items and the ability to ramp up production quickly if needed, he said.

Keith Pennington 5-5-16

Medical West hospital CEO Keith Pennington talks about the first year of operation at the hospital's freestanding emergency department in Hoover, Alabama, on Thursday, May 5, 2016.

Pennington said this pandemic also helped people realize the benefits of telemedicine. People had envisioned using telemedicine more for rural patients, but it can be beneficial even for urban and suburban patients, and he expects to see that practice increase, he said.

Also, because hospital visitation has been limited and patients have been isolated and cut off from loved ones, hospital staff have become more aware of patients’ mental health needs and have focused harder on helping patients deal with the emotional impact of their condition and separation, he said.

Pennington said it also will be interesting to see when people go back to shaking hands. People have developed a better appreciation for hand washing and infection control, he said.

Even though the state is easing restrictions on mobility and business operations, it’s still very important right now for people to maintain social distancing practices, wash and sanitize their hands frequently and wear a mask when going places, he said.